local governments and states to make sure we are using it properly to affect and understand the uniqueness and variances in those communities. >> you can watch that entire interview with representative here on c-span tomorrow. right now, we take you back to the national mall where that rally on climate change is getting under way. people are gathering on the national mall as well as around the country at various locations. this event in washington is being organized by the people's climate movement, a coalition of environmental justice groups, labor unions, students, and civil rights organizations. we expect speakers to begin in the next 30 minutes or so. until then, we will show you a portion of today's open washington journal." welcome back. author and kaiser health news editor in chief elisabeth rosenthal is with us to discuss her recent piece in "new york hard toagazine on

understand medical bills are driving up the cost on health care. those indecipherable medical bills is one reason why health care costs so much. that is the crux of the first question. where does this -- where did this whole thing start? agot: it started 50 years when medicine started getting more commercialized. of course, you know, there is a logic to all of this. it is more efficient to get something in new medical code, but these bills spiral out of control. i always joke that i have a bill from a hip replacement in belgium, which is three pages long, and i can understand it even though it is in flemish. but i look at a bill in the u.s., it is so with codes and abbreviations. this serves the purposes of the

insurers and the providers, but it makes it undecipherable for patients/consumers. that is a huge problem today. host: in telling the story in the magazine, you raised a personal story of a woman named wanda. tell us about her. andt: wanda was uninsured 2013 just before the affordable care act came into effect through no fault of her own, i should say. she had one of those minor pre-existing conditions and was uninsurable at that time. she was unlucky and had a vessel burst in her head. a cerebral aneurysm is what it is called. she was airlifted to a big teaching hospital in virginia. she had an emergency procedure to save her life. she was unconscious for the better part of three weeks. home,t, when she went

medically, she was better, but then she started getting bills and they just added up and added up and added up. ultimately, it was close to $.5 million. these hospitals talk about doing community benefits. the hospitals went after her for almost the full amount. they said to her, ok, you know, $300,000,- you a less and she said, i do not have that kind of money. $100,000 ofered up her only savings and they said, no, we want the whole thing. they putting me on her house and try to go after her tax refund. she did not have one that year, so there was nothing to get. her for the screws on the better part of two years. instead of worrying about recovering from this life-threatening illness, she was worried about the bills. host: i want to read from your article and you write, only in

america where medical treatment and recovery coexist with particular, national dread, struggling to figure out the mounting piles of bills. it is the sickness that eventually afflicts most every american. it afflicts some americans harder than others, right? from reading your story, the uninsured in the paying more? guest: the uninsured pay the most. people who are lucky enough to have an insurer negotiating these bills, the insurer's rates are much lower. if you look at the explanation of benefits statements, there will be a charge of $100,000 to your insurer and your insurer pays $27,000. if you don't have someone negotiating the rates, the hospitals can go after you for the full amount. wanda, who tried her best to be a good consumer, and i was

following along with this case, so i was looking, too. that bill she was charged $300,000 for, medicare would've paid $100,000 for the hospitalization. military insurance would've paid under $100,000 in commercial insurers may have paid a bit more, but none of them would've is what0,000, and that the hospital was going after. that did not include the and lance that transported her -- that did not include ambulance or doctors bills. it was a nightmare for her. and billing nightmare after she recovered from the medical nightmare. host: how do hospitals get away with this sort of thing? well, i think what happened early on and this is what i tried to state in the first part of the book, insurance used to cover almost everything.

our employers paid for it and we did not really see premiums. the deductibles were minimum and our co-pays were fixed. so, at that time, the feeling was nobody was paying these prices, right? if you are a business, and i have to point out that most parts of our health care system , they think,t nobody is paying and consumers will not react, so the prices started escalating upward. and the consultants came at the hospital saying, hey, no one will really react to this, so if you are charging $100 now, you can charge $1000 and you can get away with it, and they did. it became this kind of inflationary war where the hospitals charge a lot of and the doctors who were working in something, why aren't we charging this much, too? all of these business

guys in the hospital making $1 million a year. we want in. were not looking because we were not paying directly for these charges, the prices got really out of control. and begat that huge gap between what you see a hospital or physician or laboratory charge, and what your insurer paid. but if you are uninsured, you are likely to get charged the full bill. as we are all facing higher to duck the bulls and copayments as we are facing higher deductibles and areyments going up, people asking, why to have to have a $5,000 deductible? that is because we let these charges spiral out of control for the better part of 25 years and now we're all paying the price for it. host: talking to elisabeth inenthal about her piece "new york times" magazine about

the spiraling costa health care. go to massachusetts with kendall on the line. kendall is insured. what is been your experience? caller: my experience is when , i wasre came into play on medicare. sometimes i would be a was $400 to $600 a month and my insurance was paying. and now i'm getting side effects from some of the drugs. people say this is obamacare. it is like one million people marched towards this. we lost connection between the difference between democracy and

capitalism, and health care is at the center of that it is donald trump was able to tap into a type of anger that was in the society, because it is capitalistic background, and the two major problems in the world i believe our loneliness and overpopulation. many things in life just doesn't just seems so contradictory. overpopulation and loneliness. i heard a statistic with the opioid crisis that lesson 5% of -- we ares population less than 5% of the world's population, but consume the majority of the opiates. how we get out of this have to begin in communities and at the local level. it just seems that the

heightened hatred is not only affecting us internationally in a very scary for a lot of people, but as far as health care goes, it is really affecting people on a very personal level, too. guest: yes. you are hitting on a number of points, which are really important. the first one is that people tend to blame everything they don't like on obamacare. the same phenomenon that we are seeing in obamacare of the rising premiums, rising co-pays, ,rugs that were covered before are happening in the commercial market. the reason is the prices. we had let them get out of control. we have tended in the past to think of insurers as being kind of our advocates. they take in premiums and the payout claims.

and when the claims, the prices on those claims rise as they are doing phenomenally with drug prices as we have seen in the last two years, their answer is not to say, we will eat that. we -- they say, we will pass that along to the patients. we really have to focus on the prices, and unfortunately, patients has to be a part of that conversation and say to their doctor, when i went to the pharmacy, that drug was $600. your doctor has probably no idea what that drug costs and that the insurer is not covered in very well, and there may be alternatives. employerss to ask our , who had been at the sleep -- who have been asleep at the wheel, to push back and say to a hospital, if you are employed by a big local employer, they

should be talking to your local hospital and saying, we are not paying $100,000 for a knee replacement. we know it can be done for far less than that. some big employers in california are doing that now with something called reference pricing. it helps patients and those big bills. they also set a reference price for knee replacements of about $35,000. guess what? ofause they had tons employees, the hospital, many of them charging $100,000 said, we can do it for that and he will take that. we have to start rolling back these prices. and patients, employers, and physicians really need to get together to apply pressure in that direction. it won't change overnight, but we have to turn this ship of health care. let's go to west palm beach, florida where john is on the line calling on the insurer's line. hi, john. caller: good morning.

you mentioned when this began, actually you are two years off. it was 52 years ago, 1965, when medicare and medicaid that passed in the government became that third payer. price,er that pace any -- that here that pays any price that any cost. no one wants to think about what is driving the cost? the doctors, hospitals, insurance companies -- whoever it is going to be are not going to take interest in it. i had the pleasure of cleaning mother's home and she kept every bill because she grew up in the depression, and we used to have dr. bills from the early 1960's were a doctor would come to our house for $10. sistersbill where my when and to get their tonsils out and it was $10 to the hospital. if you took a graft and drew it -- if you took a graft and drew

it from 1965 two today, there would be a huge spike. my insurance premiums have gone up 100% in the last three years. if you don't get government out of it, you are not directly paying for your costs. you don't go to the grocery store without your insurance card. you don't go to the gas station and without your insurance card. that is the problem. you should only have insurance for your medical bills if it is catastrophic. host: would you think about that? --what do you think about that? guest: i should say that medicare does set prices. it does have many flaws, but it does said prices for hospital stays. this medical system with its profit motive, is very creative. if medicare says, we will only pay $600 for that procedure, you

know, the doctors and hospitals will figure out, well, we will add on a scan or send off a few other blood tests and try to make up that income. colink this notion of the mentioned, which is an interesting one because my dad was a physician in that era, and i remember watching them right out bills for patients paying not a-pocket -- that is bad idea. the problem is that everything in medicine costs so much that if we say, we are going to only have insurance for catastrophic care and you will as people to pay for their doctor has to visit out-of-pocket, one of my kids went for a simple office visit with it year, nose, and throat doctor --for a simple office visit in that resulted in a $2500 bill. if we were all on her own, it is hard to argue back against the

bill of that size and even ander to whip out a card pay for it. the idea of people paying out of pocket will work once we reined in these costs. but if it paying out-of-pocket, is patients having skin in the game, was logically works in -- in the game, logically works in many countries. in a country like ours where an mri might cost $500 in one place $10,000 atly another, if you are asking people to send me pay 25% co-pays, you are talking not rgan in the game, but asn o -- but an organ in the game.

how do we apply this in 2017 given the cost probably have? we have enjoyed calling from bethany, oklahoma on the uninsured line. caller: good morning and thank you for c-span. i want to tell a story that happened in 1995 to my dad. this is before obamacare. before any kind of changes is happening. he worked for transamerica for 25 years and never filed a claim with blue cross. he got non-hodgkin's lymphoma and at the time, i was living in hawaii. he called me on father's day in 1995 and he was crying. he was very upset in very weak. that is when he told me about his cancer. and he said, blue cross had denied his chemotherapy and has specialist dr.. it was a subset of the lipoma

due to radiation exposure. they denied his doctor and they denied it chemotherapy, which was $1200 a week. there was nothing in his policy that said that. i said, dad, i am moving back with you and we're what to figure this out. in two weeks, i moved from hawaii to san francisco and we hired an attorney and wanting to blue cross, and we got attorneyo blue cross, and we got covered. and because of that, he lived eight more years. when you are weak and tired from a disease, you shouldn't -- you are fighting for your life and should not have to fight an insurance company. i was so mad i felt like i could have swum back. insurance companies make profits for denying care. as others we have a system like that, it will never work. thank you. thank you for this guest. yeah, i think this is a

real tragic issue. when people should be focusing on their illness, when they should be focusing on her chemotherapy, or hair loss, or paying, or recovery, they are focusing on bills and on denials and fighting for what they want or need. the caller makes a good point. this was early on in this kind of move toward more commercial health care. again, they are for profit companies. their first obligation is to their shoulders -- is to their shareholders. deny that, ort, don't not if it is medically necessary, and your poor doctors have to get on the phone and explained why it is necessary. dr. spend the percent of their food time doing these negotiations.

that is not what i want my doctor doing. other point is sadly, union advocate in your corner and you need to advocate for yourself because what you find, tragic as this is, you find that the squeaky will get the grease. it youwill say that really did not have to pay. they will say, great, we tried it and we got it. i literally settle a hospital ceo, if nobody pesos high prices, why do you charge them? the first answer is, that is the starting point of the negotiation with the insurers. if you ask for $1 million and get $.5 million, that is pretty good. the other thing he said to me, which was really shocking, because sometimes someone comes in with a suitcase full of cash and we will. . that is not ok.

ast of us did not, with suitcase full of cash, but the checks -- but we buy but we write checks. i tell everyone, ask, ask, ask. don't just pay. as for itemization. look at the bills. you will find things on hospital bills that did not happen. i have one person in the book with baby. he and his wife got a bill for circumcision. he knew his baby was not circumcised, right. great example. your insured does not know that, you know it and you should push back. when we all start pushing back more, then you will get results and hospitals will get rid of those billing errors. and how insurers won't just pay thing so easily because we will be saying no, you cannot raise our premiums. the are not going to just write

check city more. we demand clarity and transparency of your paper. host: there was a page in a magazine --one notable aspect system, forlth-care every person pushing to profit, there is another doing his or her best to protect patients. facebooknd help on a group. there were former medical hospital coders open to helping her out. what other resources are available for people to advocate for themselves? guest: i tried to provide a bunch of them in the book. at the "new york times," i became the resource for the entire group. there are many online resources that will tell you what is the average cost for colonoscopy in my zip code?

you can look at that and then go back to the facility and say, you know what, i know you are charging me $5,000, but i could get it for $5,000. -- i can get it for $1500. your doctor should partner with you to make it happen. my doctor knows what radiology facilities he trusts. when i need a next rate, i ask them, which one is cheaper? he may not know that the first time a patient asks, but over time, it is a dr.'s job to know that and to say to the one charging $1000 for a simple x-ray, no, i will not refer patients to you anymore because i don't want you or pick up my patients. likewise something i do now is when my doctor says, i need a lab test, i say, ok fine. , most dr.'sld know

computers are programmed to send the tests to where the doctors affiliated. that is how the record system works, but that hospital is most likely the most expensive place in your area to get those blood tests done. , send it todoctor one of the commercial labs. they will do the same test that the hospital might of charge $700 for for seven dollars. livers started using the -- believers we have, the system will have to respond to us. -- the facebook group is always to empower patients to create a movement to give us a voice because when all of these plans, whether it is the aca other republican replacement plan, are negotiated in washington, the hospitals are patientsbying, but

don't have a say. in thekind of the ponds game and we have to stop accepting that related -- to stop except that role. host: we have a tweet of a former paramedic. thatsaid that -- he said we would charge the maximum that medicare would pay. guest: there is a section of the book how ambulance companies have moved from being voluntary for the love of helping you, andow charging often charge you the maximum. it could run you $2000. when i felt jogging in new york

and columbia university, all the students said, should we call in your millions, and i said no -- said, should we call an ambulance, and i said no. are outulance companies of insurance networks, so you will be paying for it but it is crazy and it is wrong. -- so you will be paying for it. it is crazy. and it is wrong. host: let's go to paul. what you want to share? caller: i have some concern about the way this is being discussed. this is very, very difficult actually do. there are these examples of not --nto a hospital and but they hospital -- there are

these examples of going into a hospital, but the doctor is not in network. if you call up the insurance, they negotiate the price. the idea that you are going to be a savvy consumer, great ideas, but actually doing it is kind of --is very difficult. there is a medical industrial complex that is draining this country. a tremendous percentage of gdp compared to other countries -- when you mention the cost of procedures, no other country -- there was an article -- nobody pays what we pay for a hip replacement. it is incredibly expensive. ist i don't understand, why it so much more expensive to get a knee replacement? so much more expensive for an appendectomy?

expensive and any other country according to this "washington post" article? one final point -- when you are shopping for insurance, the idea that you know what you are getting -- no you don't. you do not know what specialist will be in network. how was somebody supposed to be savvy enough to know that you will be waiting a long time to see the specialist? and you will probably want to go out a network. i find it so frustrating. will let you respond. thank you for the time. guest: so many good points here. yes, we are not a free market. what is all the money go? high-profile occasion got a hip replacement in belgium for $13,000, including airfare. that same hip replacement in this country would probably be

billed at about $100,000. where is the money going? in our country, there are several things we do differently than every other country. we don't set prices. most other country set prices for medicine, procedures. that is not necessarily the government coming in and going, you doctors, this is what you will charge. there is a massive negotiation between dr.'s, insurers, the government, policy experts about what is a reasonable cost for this? , thewith hip replacements implants, which in our country, the device makers get away with charging $20,000. in belgium, they may say that is worth $3300. in this country come every step of the way there are middlemen taking a bit off profits. in this long chain of profit, we end up with these big bills.

if a hospital and a joint maker cannot approve on a price, they will hire a negotiator and go through a joint broker. people who get to replacement should know in the u.s., there is someone from the joint manufacturing -- but manufacture in the hospital helping the doctor. you see all of the ways that the country courage is high prices. in terms of being a consumer, incredibly difficult. this notion that people should shop every year for a new policy to get a better deal. it would be mind boggling to try and do that in a smart way. try to offer guidelines in the book because there are ways to do it better than most people do it now, so you don't get so surprised. but because our information is sent perfect -- the because of information is not perfect, it is hard to do. we should be asking our

insurance regulators for its accurate insurance directories. if i buy an insurance policy for a year, my doctors can move in and out of it during that year. i don't understand why those policies cannot be as accurate as expedia. i know exactly what a flight low-cost -- what a flight low-cost in two weeks. this business of in network and having to call three doctors that is really in your network that can see you within three months is the ridiculous -- month is ridiculous. insurance regulators should put a stop to this nonsense. we should be electing consumer advocates rather than insurance industry veterans who normally control this and most days. finally, with the out-of-network dilling, if you are in new york -- and this is why i want people to ask and fight back -- new york has surprised -- new york has a surprise billing law.

room and the emergency the er and reality is our out-of-network. thatw york, there is a law says if you encounter that, you download a form on the internet and i put the link in the book. you sent it to the hospital and the insurer and you are absolved of paying and say you deal with it. i encourage everyone, even if your state doesn't have a law to that effect, to download that form and use it to say, no. if i go to in network hospital, i expect that every doctor who sees me in that hospital is in knowrk because hospitals what doctors are network and i don't. when you sign those consent forms at the hospitals to pay whatever your insurance doesn't cover, write in there, as long as the services are within my network. it may not work the first time,

but if we all start doing it, it will result in legislation if we start voting for insurance commissioners who protect consumers rather than the insurance industry. i think we will start seeing the system term. it is a big burden to put on patients now. the tools are totally imperfect. there is not much price transparency, but the more we ask, the more we will get. i am working that i am waiting for the first new york hospital to put on their billboard -- no surprise charges and upfront pricing. i think we can get there. they do that in france. in australia, it is a patient's right to have a binding estimate of charges before you are admitted to the hospital. a lot of what we do is elected. we can ask for that. it will be hard to get at the beginning. there will be this "we can't tell you." i'm sorry, but the hospital,

provider, they know your insurance. when you go to the pharmacy, they tell you exactly what you are going to pay. that is what computers are for. host: elizabeth rosenthal. we were talking about your article that appears in "new york times" magazine. thank you for >> what do we do when our water is under attack. >>